Abstract

Background: Pemphigus vulgaris (PV) is an autoimmune bullous disorder that is fatal if left untreated. High dose systemic corticosteroids are the basis of therapy. The addition of immunosuppressive agents has improved the disease outcome and reduced the required corticosteroid dose and related toxicity. ...
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Background: Pemphigus vulgaris (PV) is an autoimmune bullous disorder that is fatal if left untreated. High dose systemic corticosteroids are the basis of therapy. The addition of immunosuppressive agents has improved the disease outcome and reduced the required corticosteroid dose and related toxicity. Mycophenolate mofetil is increasingly used as a steroid-sparing agent in immunotherapy of PV. Herein, we tried to appraise the efficacy of mycophenolate mofetil and topical clobetasol in the control of the major relapses of pemphigus vulgaris. Method: Seventeen patients with severe relapse of pemphigus vulgaris were included in this study. All patients had complete remission on/off therapy before this period of recurrence. The patients were treated with 2g/day mycophenolate mofetil and 25-35g/day topical clobetasol propionate ointment. All patients were monitored for the side effects of therapy. Result: The patients were followed for a mean period of 12.7 months. The average length of time from initiating mycophenolate to 50% control (partial remission), which occurred in all patients, was 6±1.17 weeks. Fifteen patients achieved complete remission averagely at week 20.8±7.70. The average duration of followup after complete disease control was 8 months (ranging from 2-13.5 months). Three patients were free of lesions for more than 12 months and 10 for more than 6 months. No important mycophenolate mofetil related complication was observed during treatment. Conclusion: The combination of mycophenolate mofetil and topical corticosteroid can be used to control PV relapses and taper-off corticosteroid.

Abstract

Background: Pemphigus vulgaris is a rare autoimmune disorder characterized by cutaneous and mucosal blistering. Surprisingly, the management of oral lesions has been detailed only infrequently. As current topical therapies for oral lesions are of limited efficacy, application of calcineurin inhibitors ...
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Background: Pemphigus vulgaris is a rare autoimmune disorder characterized by cutaneous and mucosal blistering. Surprisingly, the management of oral lesions has been detailed only infrequently. As current topical therapies for oral lesions are of limited efficacy, application of calcineurin inhibitors is considered to be a potential option. The aim of this essay was to investigate the efficacy of tacrolimus 0.1% ointment (Protopic®) versus triamcinolone acetonide 0.1% paste (Volon-A®) in the treatment of oral pemphigus vulgaris. Method: Fifteen patients were involved in a prospective randomized trial with a split- mouth design. After two weeks of administering study drugs, oral lesions were monitored and quantified pain and mucosal surface involvement scores were obtained. Result: Within 14 days, the degree of involvement and pain scores significantly reduced in both tacrolimus-treated and triamcinolone-treated sites, but there was no significant difference between them. No severe adverse events were observed. Conclusion: This study showed that tacrolimus could be as effective as triamcinolone acetonide in the topical treatment of oral pemphigus vulgaris.

Abstract

Background and aim: Pemphigus vulgaris is an autoimmune vesiculobullous disorder. Prior to the advent of glucocorticoid therapy, it was often fatal. Now its mortality and morbidity is due to highdose glucocorticoid complications rather than the disease itself. This study was aimed to determine the effect ...
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Background and aim: Pemphigus vulgaris is an autoimmune vesiculobullous disorder. Prior to the advent of glucocorticoid therapy, it was often fatal. Now its mortality and morbidity is due to highdose glucocorticoid complications rather than the disease itself. This study was aimed to determine the effect of dapsone as a second adjuvant in the treatment of pemphigus vulgaris.Materials and methods: In this quasi-experimental open prospective study, 22 patients with moderate to severe pemphigus vulgaris were treated with prednisolone, azathioprine and dapsone. They were observed for 12-18 months.Results: Patients consisted of 10 females and 12 males with mean age of 41.71 years. The mean duration to reach to the maintenance dose of prednisolone (7.5 mg daily) was 13 months. No major relapse was observed but minor relapses were seen in 6 patients with mean prednisolone dose of 13.8 mg daily. Hemolysis was detected in only one patient and 4 patients had a little drop in hemoglobin level. We observed no other severe dapsone induced adverse reaction.Conclusion: These findings suggest that dapsone can be used as a second adjuvant for more rapid tapering of steroid dosage without significant flare of the disease.